The Checklist: How to cut through complexity and gobbledegook to get results

We know that failure is necessary for success. We also know that making big mistakes can sometimes have disastrous consequences. Complexity is a requirement for most jobs today. Where a specialist was once sufficient, today super specialists are the norm in many sectors. Can a simple checklist battle complexity and increase individual and team success?

In a the New Yorker article, ‘The Checklist‘, Dr. Atul Gawande describes the rise of the super specialist in the medical profession.

In the early twentieth century, a high-school diploma and a one-year medical degree was the only requirement to practice medicine. By the end of the century, doctors needed a college degree, a four year medical degree and three to seven additional years of residency training in a specialization. Many new doctors do a fellowship, adding another one to three years of specialization.

The advantage of a super specialist in medicine, information technology, law, accounting or other fields is that more knowledge of means being better at sorting and pulling the most relevant details. Another benefit is having an ability to manage increasing complexity on the job. The main drawback with extreme complexity in teams is that serious mistakes are sometimes made when steps are missed or incorrect assumptions are made.

Information technology is a another field that suffers from over complicating things. We often hear of large IT projects with costly mistakes, ballooning costs and missed deadlines. Recent examples in 2013 are the failed launch of the universal healthcare “Obamacare” website that didn’t work for most Americans. Another failure is the chaos that followed with air traffic controllers in England after their computers mixed up days with nights.

In the age of the super specialist, communicating simply and clearly is getting harder. In a Financial Times article, ‘Beware techies talking gobbledegook‘, an IT consultant is presenting plans for a new computer system to the client’s board of directors. The board members nod in agreement during the presentation. Near the end, one board member, namely Dennis, asks the consultant to backtrack because he did not understand all the ‘gobbledegook’ language. It turns none of the board members understood either but didn’t speak up.

Much to his surprise, Dennis observed that:

“My colleagues amazingly had voted on something they didn’t understand”. “[But] the important point is this: I had to be with the installers to explain exactly what I wanted out of the system and to see it through with them.”

How often do serious mistakes happen because a small important step is missed by the team?

Solutions like asking questions and documenting procedures using simple language seems like common sense. Yet, these steps are rarely followed in organizations.

Financial markets are another sector that suffer from extreme complexity and big mistakes. As we saw in the 2008 global financial crash, complexity led to bad decisions, fear, uncertainly a prolonged global recession.

In The Big Short, Michael Lewis describes how super specialists created very complicated products that almost no one else understood.

“Bond technicians could dream up ever more complicated securities without worrying too much about government regulation–one reason why so many derivatives had been derived, one way or another, from bonds. … The bond market customer lived in perpetual fear of what he didn’t know. If Wall Street bond departments were increasingly the source of Wall Street profits, it was in part because of this: In the bond market it was still possible to make huge sums of money from the fear, and the ignorance, of customers.”

Like Information Technology, industry jargon in the financial markets is often understood only by insiders and other specialists. Others remain clueless. Projects usually involve teams with various backgrounds, skills and knowledge, where each member needs to be on the same page to have a great result.

To better manage complexity in the medical profession, Gawande suggests using simple checklists for each procedure. The example given is to create a checklist to reduce infections in patients using central intravenous lines in an Intensive Care Unit (I.C.U.). Hospitals in the state of Michigan were asked to participate in a study. Infection rates from central lines was much higher in Michigan than than the national average, leading to prolonged illness, surgery or death. Dr. Pronovost, who headed the study, borrowed the checklist idea from the aviation industry, which had been using it to successfully reduce crashes for decades.

For doctors, the checklist to be used for inserting central lines to avoid further infection seemed trivial, dumb and a little insulting. The five point checklist included:

Wash hands with soap;

Clean the patient’s skin with antiseptic;

Cover the patient’s entire body with sterile drapes;

Wear a mask, hat, sterile gown and gloves;

Put a sterile dressing over the insertion site after the line is in

While the points are obvious, Dr. Pronovost knew about a third of doctors were skipping at least one of the critical steps. He asked hospital management to give nurses in the I.C.U. the authority to intervene if doctors didn’t follow every step on the checklist.

The results of using the checklist were surprisingly positive:

In the first three months, the infection rate in Michigan’s I.C.U.s decreased by sixty-six per cent. The typical I.C.U. cut its quarterly infection rate to zero. In the first eighteen months, the participating hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. In a follow-up book called The Checklist Manifesto, Gawande cites many cases across a range of industries on how checklists reduce complexity and increase results.

Complexity is a fact of life in most jobs today. Mistakes happen. What checklist can you create today to improve you and your teams performance in a particular area. Feel free to share your answer in the comments below.